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217 W Georgia Ave Ste 120 Nampa ID 83686-6812 | |
| (208) 498-1760 | |
| (208) 498-1769 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 217 W Georgia Ave Ste 120, Nampa, Idaho |
| Authorized Official Name and Position | Deo Marie Peppersack (OWNER) |
| Authorized Official Contact | 2084981760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
353 W Iowa Ave Nampa ID 83686-2856 Ph: (208) 498-1760 | 217 W Georgia Ave Ste 120 Nampa ID 83686-6812 Ph: (208) 498-1760 |
| NPI Number | 1669612271 |
|---|---|
| Provider Enumeration Date | 02/23/2009 |
| Last Update Date | 03/09/2016 |
| Medicare PECOS PAC ID | 7517024169 |
|---|---|
| Medicare Enrollment ID | O20090325000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669612271 | NPI | - | NPPES |
| 8083269 | Medicaid | ID | |
| 806976700 | Medicaid | ID |
| Provider Name | Deo M Peppersack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770538811 PECOS PAC ID: 1850352915 Enrollment ID: I20041021000818 |
| Provider Name | Julie L Schmidt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932346335 PECOS PAC ID: 0840468088 Enrollment ID: I20110714000306 |
| Provider Name | Rebekah G Fayette |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1043690175 PECOS PAC ID: 6406162841 Enrollment ID: I20161215002288 |
| Provider Name | Jana W Duncan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396162905 PECOS PAC ID: 7416234414 Enrollment ID: I20170428002017 |
| Provider Name | Brandy D Fitchett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902315021 PECOS PAC ID: 0042578569 Enrollment ID: I20171211001054 |
| Provider Name | Robert Hadley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639666811 PECOS PAC ID: 4880010545 Enrollment ID: I20200812003068 |
| Provider Name | Mckenzie Morcom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417601840 PECOS PAC ID: 4789079617 Enrollment ID: I20220311001093 |
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